How one man with type 1 uses diabetes devices in his daily life
You could say I’m an early adopter. I enjoy experimenting with new technology, especially when it comes to my diabetes management. Through my three decades living with diabetes, I’ve seen a lot of new devices come on the market and a few great devices go—the Freestyle Navigator continuous glucose monitor (CGM) and Deltec Cozmo insulin pump, both no longer available, come to mind. Sure, using technology to manage diabetes adds a lot of extra time and energy to my day, which often frustrates me. But overall, each device, gadget, app, and tool adds a layer of usefulness that makes it easy for me to accept and appreciate the high-tech assistance.
Here’s what my typical day using diabetes devices looks like:
3:42 a.m. My continuous glucose monitor, a Dexcom G4 Platinum, wakes my wife, who wakes me. It’s a low blood glucose alert: 62 mg/dl. I eat five Glucolift glucose tablets (20 grams of carbohydrate) and go back to sleep, too tired to confirm the CGM reading with a traditional blood glucose test.
8:15 a.m. Time to wake up. I test my blood glucose with my Accu-Chek Compact Plus meter: 102 mg/dl. I head downstairs to spend some time with my Bible and daily devotional before the day gets going.
8:51 a.m. I’m working to get my daughter in the car and off to school, and in the middle of everything I remember that I need to start a temporary basal rate on my insulin pump for basketball at 10:30 a.m. The temporary basal rate allows me to decrease (or increase) my steady background insulin for a set amount of time. I usually try to do this one to two hours before I exercise. I’m frustrated because I can’t program my pump to start the temporary basal ahead of time. I wish I could set it now, while I’m thinking of it, and not risk forgetting at 10:30 a.m.
9:25 a.m. Just finished driving my daughter to school and I stop for a fast-food breakfast sandwich, hash browns, and a diet soda. Before digging in, I test my blood glucose with my iBGStar meter, which I carry with me because it’s small enough to fit in my pocket. I’m 137 mg/dl even though I haven’t eaten since my last test. Why does it rise like that? I enter the result plus my breakfast’s carb count into my Cozmo pump (it was discontinued in 2009, but I still use mine, which works fine despite being well past its warranty). My CGM is calling for a calibration reading, so I enter my blood glucose number into that device as well. I also enter everything into Diabetes Companion by mySugr, an iPhone diabetes logbook app, for tracking purposes.
10:25 a.m. I’m in a Skype meeting when my CGM alerts me to a low: 71 mg/dl and falling. This is concerning because I still have a lot of insulin on board. I test my blood sugar with my meter: 67 mg/dl. The person I’m meeting with also has type 1 diabetes, so these actions are not disruptive or embarrassing, though they are a slight distraction for me. I grab some glucose tablets and eat them as the meeting continues. I’m also able to enter the low and the carb grams of the glucose tablets into my Diabetes Companion app without too much disruption.
11:25 a.m. I glance at my CGM on the way out the door to basketball: 94 mg/dl. Shoot! I forgot to start my temporary basal rate for basketball. I’ll be playing in less than 35 minutes, and a temporary basal rate needs at least 60 to 90 minutes to have any effect on my blood sugar. I program the temporary rate—a lower basal rate than normal so my pump releases less insulin while I’m exercising and naturally lowering my glucose level—into my pump and grab a quick snack on the way to the gym, trying to figure out how many carbs I need to offset the late start on the temporary basal rate.
12:15 p.m. I’m feeling OK during the basketball game, but a quick glance at my CGM shows my blood glucose is at 156 mg/dl—and rising fast. Was my snack too much? Or will this even out? I pull my pump out of the waistband I wear during basketball and check how much insulin I have on board. There’s still a decent amount, so I decide to be patient and see how it plays out.
12:35 p.m. During a short break between games, I notice my CGM is reading 239 mg/dl. I test my blood glucose, and my iBGStar meter shows my glucose is at 183 mg/dl. Quite a difference. That happens a lot when I exercise, and I’m not sure why.
1:20 p.m. Basketball has been really intense since my last test, and I’m feeling weird. Not sure if I’m tired from the workout or if I’m getting low. I really need to test. The game wraps up, and I check my CGM: My level is at 153 mg/dl and dropping quickly. A finger stick on the iBGStar shows my blood glucose at 54 mg/dl. Yikes! I grab a Level Glucose Gel pack and suck it down. I love these glucose gels during basketball because I can eat them so quickly.
1:34 p.m. After sitting out for a while to let my blood glucose rise, I’m back on the court. Yet I still feel really wiped out. It’s frustrating how hypoglycemia during exercise can drain all of my energy.
2:30 p.m. After basketball and a shower, I stop for lunch. I go through the same routine as at breakfast: I test my blood glucose with my meter (186 mg/dl), enter my carbs and current blood glucose into my pump, and let my pump calculate my insulin dose. During lunch, I spend time with the Diabetes Companion app on my phone, entering all of the blood glucose readings I took and the grams of carbohydrate I consumed during basketball. I also remember to enter the temp rate into the app as I was too rushed to record it at the time.
3:07 p.m. Ouch! Stupid test-strip bottle in my pocket jabbed me the wrong way. While the iBGStar meter is small and easy to carry, the vial of test strips is huge and doesn’t comfortably fit in my pocket. I wish someone would make an easier way to carry test strips.
4:17 p.m. I hear the high blood glucose alert on my CGM. I can’t actually look at it while I’m driving because it’s in my pocket, but the two buzzes (as opposed to three) tell me it’s a high, not low, blood glucose alert. It continues to vibrate every few minutes, now with an added beep-beep because I haven’t acknowledged it. I’d love to silence the alert, but the device is tucked away. There’s no safe way to get at it while I’m driving. It’ll have to wait.
4:31 p.m. I get home and am able to take a look at my angry Dexcom. My blood glucose is at 254 mg/dl and rising. My finger stick is in agreement: 269 mg/dl. I enter the reading into my Diabetes Companion app, but don’t take a correction bolus because I still have insulin on board from lunch and tend to be more sensitive to insulin after exercise.
6 p.m. According to my CGM, my blood glucose (now 231 mg/dl) is slowly dropping back into range. The tape around the sensor and transmitter started pulling loose during basketball today, so I’m going to reinforce it with a bit of Skin-Tac adhesive wipe and Flexifix tape. That should hold it for another few days.
7:15 p.m. I’ve been hungry for a while but didn’t want to eat with my blood glucose elevated. My CGM now shows a reading of 154 mg/dl and falling, which is good enough for me. I check my blood sugar:146 mg/dl. Time for burritos. I program the grams of carbohydrate and my blood glucose level into my pump. As I take the first few bites, I also record everything into my Diabetes Companion app. After dinner, it’s back to work for a while.
9:30 p.m. I’m tired. Is it blood sugar related? My CGM says my glucose level is 178 mg/dl. I decide to wrap things up and get ready for bed.
9:49 p.m. After a nice, hot shower I am in bed with a good book (Good Like This by Peter Arpesella, a great author who also has type 1 diabetes), and I enjoy spending a few minutes just winding down and reading.
10:15 p.m. Before finally turning in for the night, I take one last look at my CGM (149 mg/dl and steady), do one last finger stick with my bedside meter (151 mg/dl), and enter the reading into my Diabetes Companion app. I set my morning alarm with an app called Sleep Cycle. With any luck, I won’t be disturbed by a high or low during the night and will be well rested in the morning, ready to tackle another day with diabetes.
Disclosures: Scott K. Johnson is a former employee of Smiths Medical, manufacturer of the now-discontinued Deltec Cozmo pump. He has a current business relationship with mySugr, received his Accu-Chek Nano meter and some strips from Accu-Chek free of charge, and received a review copy of Good Like This in exchange for an honest blog review. Learn more about Scott at www.scottsdiabetes.com.